Under The Knife: Sale treatment could provide map for Strasburg

As many prepare for fantasy football drafts, it's still good to remember that baseball season is still chugging along, and with it injuries never cease.

Sale's season has been pretty impressive -- almost as impressive as that of Stephen Strasburg. The differences in how they are being handled is intriguing, since we're looking at the opposite ends of the spectrum in terms of injury results. The five-year medical rankings for the Nats are finally meaningful, since there's no longer the excuse of poor facilities or a low budget. The White Sox are on top of almost every medhead stat there is, so is there a lesson in comparing these two young pitchers? While the world awaits the Strasburg Shutdown, the Sox have rested Sale a couple times, only to see him come back solid. Sale came off nine days of rest after a recent "dead arm" period and looked good in his first start back. It was the Royals, so don't read too much, but the Sox's flexibility and creativity with Sale is certainly something the Nats and pretty much every other team could learn from.

Stress reaction? Where did this come from? Garza's "mild strain" has now become a bony problem. Garza related to me a couple years ago that he has a stronger than normal ligament, the result of a childhood skating accident. His ligament scarred over, leaving it more resistant to tearing. I later confirmed that with other sources and confirmed with doctors that it would work how he said. I have to think that Garza's "superligament" might be pulling more on the bone, causing this stress reaction. Another pitcher might have just popped the ligament. It's telling, in that something is overloading his arm. Garza could be done for the season. The Cubs won't make that decision yet, but if he's out for more than a couple weeks, there's no reason for the Cubs to push for a return. They would like to see him pitch so that his off-season value is maximized.

A torn labrum in the hip doesn't seem like the kind of thing that could fell Helton. He's kept a football mentality almost two decades after he was a QB at Tennessee. He's played through injuries for a long time, seen his career written off a number of times, but here he is, playing at a relatively high level. I just don't feel like we've seen the last of Helton, even after surgery on Friday. Something tells me that he'll see Chipper Jones hitting and think that he wants to go out like that. We'll see sometime this offseason, but if it is the last time, he deserved more of a tip of the cap.

Things have leveled off for Bautista and that's a problem. The pain and inflammation he's had in his wrist just don't seem to be going away as expected. That has led the Blue Jays to send him for another MRI in hopes of finding out what's going on and finding a way to get him back on the field. Bautista isn't swinging a bat right now, so even if they feel good about what they see, Bautista's going to need some time before he's ready to come back, time that could include a rehab stint. With the Jays fading in the AL East, there's a chance that they shut Bautista down, especially if there's something going on with the cartilage in his wrist. Surgery on that region is very difficult and rest is the normal course for that. I'm going to a "TBD" on his expected return until we get a clearer picture (literally) on his return.

Pettitte is back on a stationary bike, but not on a mound. Pettitte's broken leg is healing, but he experienced some swelling last week that set things back slightly. He's keeping up his conditioning and doing some light work with his arm. That "light work" has sources confused, with some saying that Pettitte had to have the reins pulled pretty hard on him as he's pushed to get back quickly. Others say that Pettitte is doing some throwing, but that he's stationary or even seated for some of it. Either way, the setback wasn't significant and Pettitte can be pushed a bit more than most pitchers, given his self-awareness and his temporal situation. That is also a bit controversial, with the same sources mixed on whether Pettitte is hoping to return next season.

Byrdak isn't the most fantasy relevant player, but his torn anterior capsule raises some disturbing questions. At what point is a series of injuries a pattern? The Rangers have long had a strange streak with Thoracic Outlet Syndrome. Most think it's because they happened to have a couple, got good at recognizing it, and now have some of the leading experts. The Mets have their own pattern with capsule tears now. Byrdak is the latest, with Johan Santana and Chris Young being the other major leaguers. Both have returned, but what are the Mets doing that could cause something like this? None of the pitchers are in-system guys. There's no consistent mechanical trigger. Instead, it suggests there may be something in their conditioning work, some sort of drill or exercise that may be causing the stress. Yes, it could be just coincidence, but we have to hope that Rey Ramirez and his staff are stepping back and making sure that it's not something active. Byrdak is done for the season, but should be back at some point next season.

Jose Reyes has a minor hand injury, which may pause his hitting streak. The Marlins are looking to give their SS a day off this week to help the hand heal. Reyes has been both good and healthy this season ... Monday's tough start was just the latest sign that Yu Darvish is dealing with fatigue. That's normal and expected as he adjusts to playing in the U.S., but you need to adjust as well if Darvish is anchoring your fantasy staff. Look for the Rangers to get a bit creative as they look to October ... The Reds like what they're seeing from Joey Votto, but they also like how they're playing. That gives them some leeway, allowing him to get closer to 100 percent before a return. It won't come before mid-month. ... David Ortiz's recent injection is being reported as a marcaine injection. That's a painkiller, not an anti-inflammatory, so the relief is temporary ... Pablo Sandoval will play a couple games at San Jose (A), then should be back with the Giants this weekend ... Trevor Plouffe is amping things up, taking grounders and running. He may avoid a rehab stint and get activated on August 10 ... There's a hidden toll to no-hitters. Even Matt Cain isn't immune ... Tommy Hanson looks like he'll come off the DL as expected on Aug. 15. He should be good to go once activated in all formats ... Shaun Marcum is expected to make two rehab starts before returning. The first will come Thursday in Wisconsin (A) ... Drew Hutchison is the latest Jays pitcher to get bad news. His rehab has failed and he will need Tommy John surgery ... The disc issue in Jim Thome's neck has likely ended his season and probably his career ... The Indians think Travis Hafner's back injury is minor, but if he's unable to play Wednesday, they're going to send him for scans ... The Indians want to see Grady Sizemore play. He's gearing toward playing with Columbus (AAA) during the last two weeks of their season. If he can do that, the Indians could bring him up once the rosters expand ... The Yankees are considering activating Brett Gardner in September. He would only be able to pinch run, but with expanded rosters, it's certainly possible ... Short intro today as I'm starting work on my NFL fantasy packages. Gotta save the wrists so I don't end up in my own injury reports. You'll start seeing those, starting with the QBs, next week.